Hospital-acquired infections are a problem that can be fatal to many in the hospital. This can occur when medical care professionals do not wash their hands properly in between handling patients.

A 2010 study has revealed that only approximately 40% of healthcare providers kept to their hospitals’ hand-washing standards.

Curbing disease transmission in a simple way

According to the US Federal Centres for Disease Control and Prevention (CDC), one in 25 patients suffer from at least one hospital-acquired disease. Hence, Dr. Mark Sklansky, a professor of paediatrics at the David Geffen School of Medicine at UCLA and self-described germaphobe, launched a pilot initiative to limit the transmission of pathogens by imposing a ‘handshake-free zone’.

“We are trying to do everything to minimise hospital-acquired infection except for the most obvious and easiest thing to do in my opinion, which is to stop shaking hands,” he said.

Sklansky decided to focus on the neonatal care unit – a location which houses extremely vulnerable patients. The six-month pilot initiative was launched in 2015 at two of UCLA’s NICUs, in Westwood and Santa Monica.

Hospital staff and families of patients were made to understand the reason for handshake-free zones, which were indicated with signs featuring two hands gripping each other inside a circle with a blue line through it, and the words: “To help reduce the spread of germs, our NICU is now a handshake-free zone. Please find other ways to greet each other.”

A well-received initiative

The initiative has largely been well-received by healthcare workers – especially medical school students and nurses – and families alike, although some male doctors were less convinced of its efficacy.

Neonatologist Joanna Parga said she liked the idea when she first heard about it, although she had not been convinced of its feasibility. Shaking hands is “so ingrained in our culture”, and it is how many doctors connect with patients, she explained.

Meena Garg, medical director of the NICU in Westwood and neonatologist, concurs. Garg still feels uncomfortable declining handshakes, because patients often extend their hands in greeting.

“You feel like you are being rude,” she said.

Nevertheless, Garg recognises the handshake-free zone as a simple and inexpensive way of curbing infection. “I am the medical director, so I have to look at costs,” she said. “This doesn’t cost anything, but it may be just as important as anything else we do.”

Families of patients, too, support the idea. Brittney Scott, mother of two-week-old baby Samuel, said she had never heard of a handshake-free zone and had been “a little taken aback at first” when her instinctive offer of a handshake had been rejected by her son’s attending physician.

“But once you really understand the meaning behind it, it’s great,” she said, adding that she now prefers a smile to a handshake.

Complement, not replace the handwashing protocol

Some infectious-disease specialists have criticised the idea, believing that hospitals would do better to increase hygiene standards instead of avoiding handshakes.

Physician Herbert Fred wrote in a 2015 Texas Heart Institute Journal editorial that “the problem isn’t the handshake: it’s the hand-shaker.” Doctors should be relied upon to uphold the required levels of hygiene before interacting with patients, according to him.

International expert on hand hygiene Didier Pittet, too, said in an email that handshake-free zones are not the solution for hospital-acquired infections, simply “reflect[ing] the lack of capacity in infection prevention and control”. Other critics have also noted that these programmes could result in a relaxation of hand-washing protocols in hospitals.

Sklansky agrees that hospitals need to uphold standards for hand hygiene, and that these handshake-free zones are there to complement it.

“I actually think handshake-free zones will bring attention to the hands as vectors for disease and help improve compliance with hand hygiene,” he said.

The idea of avoiding handshakes has caught on

Though the experiment is over, the handshake-free rule continues to be adopted by staff. Sklansky hopes to determine the effectiveness of the idea in lowering infection rate, in the future.

Editor-in-chief of the American Journal of Nursing, Maureen Shawn Kennedy, believes that avoiding handshakes will indeed reduce the rate of infections. Hospital staff do sterilise their hands regularly, but it is often not done thoroughly or correctly. In addition, the presence of bacteria is virtually unavoidable.

“There are just so many reasons to avoid handshakes, even when people are washing their hands,” Kennedy said.

“Just because someone is walking around in a white coat … doesn’t mean they don’t have bacteria on their hands.” MIMS

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